| Research Background: Coronary heart disease has a very high mortality rate. However,the public know little about Myocardial Infarction (MI). Patients are not paying enoughattention to early symptoms and therefore miss the opportunity of openinginfract-related artery at an early stage. Both thrombolytic therapy and PercutaneousTransluminal Coronary Angioplasty (PTCA) are effective in increasing the survival rateof early patients with MI. But prehospital delay is rather common in both China andabroad. The median time between disease onset and treatment in hospital is84-384minwith an average of6-29h, far beyond the best treatment time in relevant guidance.International scholars have raised theories about the process of seeking medical help toexplain prehospital delay factors. Domestic reaserches are limited to sociological andclinical analysis.Research Objectives: Investigate time distribution of interval between the diseaseonset and balloon dilatation of emergency PCI patients. Analyze psychological,sociological, clinical and other factors influencing prehospital time to provide solidtheoretical basis for related time reduction.Reaserch Methods: Retrospective analysis includes samples of294cases of confirmedSTEMI with acute PCI treatment (323cases in total,29cases incomplete) in No.1affiliated hospital of Dalian Medical University. Patients are divided into differentgroups according to time interval between disease onset and balloon dilatation. Fivegroups are formed:①decision delay>1h and≤1h②transport delay>1h and≤1h③EMS or non-EMS④prehospital delay>2h and≤2h⑤time interval betweentreatment and first balloon opening>2h and≤2h. Conduct logistic analysis ofpsychological, sociological and clinical factors to find out significant factors influencing the treatment delay prehospital and inhospital.Results: Among all323cases,294cases are effective with29cases incomplete.Average time intervals between onset and balloon dilatation is100.43±83.83min fordecision delay and84.96±72.30min for transport delay. For direct transport to ourhospital the median is48.52±27.51min, while for transferred from other hospitals thetime is155.66±79.66min. Average time for prehospital delay is185.40±106.42minwith158.73±92.59min for direct transport to our hospital and237.15±112.71min fortransferred from other hospitals. The overall time is152.27±70.96min. EMS usage rateis28.6%.As for the decision to seek medical help,37.1%patients decide to go to hospital within1hour. Factors influencing decision include age, occupation, CAD (coronary arteryheart disease) history, CAD hospitalization history, consultation within1hour, suddenonset, increasingly severe symptoms, degree of pain, anxiety, afraid of influencingothers, wait for symptoms to disappear, belief of severe symptoms, attribution to heartdisease. Multi-variant regression shows that consultation within1hour and belief ofsevere symptoms are significantly negative factor of decision delay while afraid ofinfluencing others increase decision delay significantly.Analysis of transport process reveals that there are194cases of direct transport to ourhospital and100cases transferred from other hospitals. Factors influencing the processof transport include low education, health insurance, occupation, location, transfer, EMS,CAD history, attribution to heart disease. Multi-variant regression shows that EMSusage is a negatively significant factor while location is a positively significant factor.7.14%patients have less than1hour prehospital delay;29.93%patients experience lessthan2hours delay. Major elements are age, low education, health insurance, occupation,location, transfer, EMS, consultation within1hour, sudden onset, increasingly severesymptoms, degree of pain, anxiety, afraid of influencing others, belief of severesymptoms. Indicated by multi-variant regression, direct transport to our hospital andusage of EMS are significant factors decreasing prehospital delay while location andwait for symptoms to disappear are significant in increasing prehospital delay. As for means of transpoart, EMS usage is mainly influenced by low education, healthinsurance, location, transfer, consultation within1hour, sudden onset, increasinglysevere symptoms, degree of pain, anxiety, afraid of influencing others, wait forsymptoms to disappear, belief of severe symptoms. Multi-variant regression showsdirect transport to our hospital, consultation within1hour and anxiety are significantfactors increasing the usage of EMS.Factors influencing the time interval include location, time of signing for operation,time interval between treatment and live in hospital, consultation within1hour,dizziness. Time of signing for operation and time interval between treatment andmoving in ward are positively significant factors shown by multi-variant regression.Conclusion: Although decision delay still exists, it is shorter than the previous with themedian of only80min. In the process of transfer, primary hospitals are responsible fortransfer delay. More knowledge of CAD will decrease transport delay and prehospitaldelay. The usage of EMS is rather low. It is only used when patients feel anxiety. It’snecessary to help patients understand that EMS is not only for transport but also part ofearly treatment. It’s important to use EMS to transfer patients to hospitals with PCIdirectly. Although decreased in recent years, time interval between treatment and firstballoon opening is still much higher than required. Delay is mainly caused by relativessigning operation agreement, explaining operation issues and too many steps beforetreatment. Attention of doctors in emergency department to myocardial infarction mustbe improved. Sound system of myocardial infarction treatment within hospital isstrongly needed. |
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